405 or 445 cc mod? I am 5’6” and 114lbs. Will these sizes make me look heavy? If so, what sizes would you suggest. (photos)

Hi.  Although it is hard to say for sure without seeing you in person, I really think you should NOT use a 405 or 445cc moderate implant. I think either of these would be too wide for your chest.  If you want to have this volume, then a high profile implant would fit your frame better.  If you want to know for sure, go to a PS who can let you try on sizer of both styles so you can see the difference.  It will help you make up your mind when you can see it on yourself.  Best of luck!

With your frame, I think either size will look great on you. I would suggest that you also look at high profile implants. They will provide more projection and less width while still giving you a natural slope. Good luck!

Unfortunately,
we do not have a photograph of you without a bra.  We need to this to know the position of your
breasts.  405 or 445 cc implants weighs
approximately 1 lb and will descend.  After
a breast augmentation the added implant weight creates breast descent.  These breasts are more abdominal than chest
and it makes them look older, heavier and more matronly.  You may consider a breast lift and fat
transfers instead.  Best Wishes,Gary Horndeski, M.D.

Patients often think in terms of cup size when considering augmentation. Unfortunately, devices are sized in terms of milliliters (cc) of volume. This can lead to some confusion when sizing. Additionally, it is important to remember that cup size itself is not standardized with variations from one manufacturer to another. Unfortunately, as many women can attest their cup size in an industry leader such as VS is not necessarily transferable to another brand.
A general rule of thumb is that 125cc can represent somewhere between 1/2 to a full cup size increase. Smaller volume differentials (25-50cc) are typically less consequential representing a volume change of less than a shot glass. However, I have found these numbers, at least anecdotally, to be of little help. Patients often present with notions/goals which do not correlate with these sorts of sterile volumetric assessments.
When sizing patients, there are a number of useful tools including:
-3D imaging (has the added benefit of offering a volumetric analysis of the pre-operative breast)
-Breast sizers (rice bags)
-Goal photos
I also recommend that patients commit to a particular look rather than a cup size. Once a patient settles on a look that pleases them the overall cup size increase becomes less relevant.The key to obtaining a natural result is to stay within the parameters defined by your BWD. This will ensure that you avoid the dreaded "fake" look. 
The question of "too heavy" is relative. The safest approach is to stay within the boundaries of your BWD. I would recommend a measure of patience as it will take several months for settling prior to obtaining a final result.Without measurements, it is difficult to offer any specific recommendations. Based upon your photos and frame, I would encourage a more conservative volume for a more "natural" result. It is important to remember that typically, small framed individuals do not have large breasts.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Hi, thanks for your question and photos.
I always tell my patients to think about volume last. It is the least important choice, even just considering physical dimensions. Breast implants are 3D structures, so if you get the width, height and projection right then the volume is determined for you mathematically. 
What does this mean practically? First of all, get an implant of similar or slightly smaller width to your own breast footprint. I would take a guess that your breast base width will be around 12cm, but your surgeon will probably have measured this and will be able to advise. If you don't then the implant will probably be visible on the inside or outside (or both sides) of your breasts, and most people don't want that. I sometimes hear patients wish to exceed their breast base width to achieve a particular volume they have in their head, but I find that a crazy way of conceptualizing the process. What use is that "extra" volume it's all localized under your armpit in a too-wide implant? I have never ever met a woman who wished she had more breast tissue under her armpit. 
Second, choose your implant height. If you're getting round implants then it's easy - the height is the same as the width (because they're around!). If you're getting teardrop/anatomic ones, they can be wider than they are tall or taller than they are wide, and a good principle is to match your body - some people are broad and others are long. There are mathematical ratios which your PS can use to guide this, but essentially you will know whether you are broad or long (spoiler alert: you're neutral/long).
Finally, choose your profile - how much you want the implant to project. This is your personal choice, and sizers/3D simulation will help with this. Do you want low profile (a very slim, athletic look), medium profile (a more significant but still relatively modest enhancement, perhaps a more natural look), high profile (a more obviously implanted look) or very high profile (if want people's attention to be first on your breasts and then you, go for these!).
Once you have those three things, the volume is determined for you. Doing it this way round takes all the agony out of the decision, and is stresses that the implant choice has to be right for your body - there's no point comparing what volume looked good in someone else because they are not you.
Best of luck!

As noted below we make recommendations on size of implant based not just on volume but also on measurements of your chest. Too wide an implant will not look good and may rest in your armpit area. The best bet is to have a consultation with a board certified plastic surgeon, and try different volumes based on your measurements.

Thank you for your question. Pictures you provided are difficult to judge. Size of implant depending on your breast diameter, anatomy, your goal etc. Please consult with a board certified PS for evaluation and to discuss your goals.

Yes, having too large/wide of an implant can make you look heavy.  I would actually advise against what you are considering currently.  For patients such as yourself, I generally recommend high profile implants as they are narrower and usually fit tall/thin frames better.  Also, you can generally get the same effect with a smaller high profile implant which also comes with advantages.  Try on high profile implants in the 350cc range.  I think you'll be pleasantly surprised.  Good luck!

Thank you for the question.  Despite your good description of body type and goals, online consultants will not be able to provide you with specific enough advice to be truly helpful.  Ultimately, careful selection of plastic surgeon and careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging)  as well as careful measurements (dimensional planning) will be critical. 
***Given your concerns, it is definitely worth spending more time (preferably prior to the date of surgery) with your plastic surgeon to discuss further.  It will be important for many reasons, that you feel comfortable that you and your plastic surgeon are on the "same page" prior to proceeding.
 Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup" or "look heavy" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.

One of the more frequent questions I'm asked as an aesthetic plastic surgeon for patients considering breast implants is "how do I know what size, and shape I need?” The answer to this question has changed dramatically throughout the 25 years that I've been doing breast augmentation. I've also learned that the words that patients used to describe either what they want or don't want can be completely misleading into what I interpret their meaning to be. Therefore, I like to request that our patients considering breast augmentation bring in photos of both what they think they like and what they don't like. There seems to be a multitude of sources on the Internet where these photos can be downloaded. By looking at the patient's desires, I get a better understanding of what they want. We no longer recommend that we place the exact implant on top of the existing breasts and then place a stretchy bra over it to give us any idea what that exact same implant under the muscle would produce in size. That method, in my opinion, will always over represent what the actual result will be. If you are going to use a sizing type method, then Mentor makes a shell sizing system such that, when the shell size corresponding to the implant that it represents is placed over the existing breast and in a bra, it will better represent what that size implant under the breast and muscle will look like. We've also used 3-D imaging called Vectra® since its inception some 6 to 7 years ago. With this method, a three-dimensional photograph of the actual patient is taken and can be seen on a large screen television by both the physician and perspective breast augmentation patient at the same time. We then can place all of the different implants that are available under that image and decide what size, shape, fill ratio, and height to base width relationships will look best for each patient. Silicone gel breast implants come basically into shapes either round or shaped. They also come with either a textured or smooth surface. In my mind, there are advantages and disadvantages of every scenario and combination of those choices. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. It's then very simple to just look at size and ratio projection to base width and select the perfect implant for that patients shape and desire. Sometimes we would like to use a textured surface implant. Here the advantages are that the textured surface implants tend to migrate less in the pocket, as there is some frictional resistance to motion. Another advantage of textured implants is that the capsular contracture rate, especially when implants put above the muscle, is less than for smooth wall implants. Shaped implants, because we do not want them to turn in the pocket, are always textured. My planning method to optimize the best implant for each patient is begun with a measurement of the base width of the breast. We would then like to subtract about a centimeter and a half total off of that number so as to have coverage of breast tissue over the implant. We then will have a range of implants whose base width matches that number. If we go larger than that number, which sometimes patients will want, we as plastic surgeons know that these larger implants can have more problems down the line. For instance, larger implants may migrate below the crease which one has to lower at the time of surgery in order to get the implant in. When these implants migrate below the natural crease, they can create a second crease in what we call a "double bubble". Large implants can also; because of the pressure they put on the overlying breast tissue, thin that tissue out such that there is less overlying breast tissue over the implant as time passes. After we have the base width, our next decision needs to be what is the ratio of the base width to the projection of the implant. Essentially, there are usually four choices ranging from fairly flat which is called low-profile, to progressively more height and less width with the same volume of silicone gel, which is called ultrahigh profile. There are two profiles in between which are the ones more commonly used and these are called moderate profile and moderate profile plus. Common scenarios in which taller implants would be desired may be in patients who want a larger look than their natural base with would allow or have a fair amount of loose overlying skin that were trying to hold up. For patients who want a more natural look, a moderate profile or moderate profile plus shape is more desirable. There are also anatomically shaped implants. Rather than being around these implants can either be taller than they are wide or wider than they are tall. There are good reasons in patients to use either. For instance, in the patient's with very widely spaced breasts and a large breastbone, a shaped implant that's wider than it is tall can help hide that a little bit. Another example of the patient in who a shaped implant would be best, is that patient with laxity after childbirth or weight loss. When the nipple is just at the level of the inframammary crease, we can sometimes get away with a tall implant that is anatomically shaped such that the nipple when is it at the lower two thirds of the breast mound created by the implant still looks good and natural and may obviate the need for a breast lift. By spending some time, long before the operation takes place, using the Vectra® 3-D imaging method, we can decide what type, shape, and ratio of width to height would best serve the patient's needs. We can then avoid what is sometimes done which is the placement of sizers at the time of surgery. These sizers, in my opinion, have a few negative implications. One is that there is a cost inherent in using them and usually multiple ones are needed to make a decision as to which implant would look best. I also believe that placing sizers in and out of the breast pocket can be traumatic to that pocket and can cause bleeding. For me, the state-of-the-art in today's breast augmentation is to decide long before the operation exactly which implant would look best using computer animation. A new wrinkle into the choice of breast implants is that breast implants now come with silicone gel that is filled to a higher volume in the shell where it is placed. This will allow for a round smooth implant, for instance to collapse less in the upright position mimicking more of the look of the shaped implant. When patients show me a photo of a very rounded upper part her breast, I would likely choose one of these higher volumes implants such as the Natrelle Inspira® silicone gel breast implant. Often times patients will present with breasts that are of different sizes. One of the options to correct this is to use breast implants of different sizes in order to best create symmetry. One of the newer methods to help in symmetry creation is to do what we call a hybrid breast augmentation. In the hybrid breast augmentation, the patient who has asymmetry of the breast to begin can have matching silicone gel implants placed and the overlying breast tissue can be made to look the same in volume and shape by using fat grafting. In that way, no matter what the change in weight of the patient is over time, the breast is more likely to have the same or similar size. When it comes to symmetry, I like to tell our patients that they should consider their breasts to be sisters that live across the railroad tracks from each other rather than twins. With proper preoperative planning and flawless execution of breast augmentation, this can be one of the most satisfying aesthetic plastic surgery outcomes for both patients and physicians.